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100 Year Lifestyle Chiropractor in Marietta GA
Phone: 678-956-1598
Make Your Health a Priority!

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Patient Forms

New Patient Application for Care

This form is the New Patient Application for Care at Revolution Chiropractic. Please download, print, and fill it out as thoroughly as possible to bring with you to your consultation and exam. It will take about 15 minutes to complete, give or take, and doing it ahead of time will save you from having to do it in the office!



New Pediatric Patient Application For Care

Parents, please fill out this form for your child if they are under 7 years of age and bring it with you to your family's chiropractic consultation and exam.